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A Multicenter Randomized Clinical Trial of Hemodialysis Access Blood Flow Surveillance Compared to Standard of Care: The Hemodialysis Access Surveillance Evaluation (HASE) Study

INTRODUCTION: Arteriovenous (AV) access thrombosis remains 1 of the most troubling AV access–related complications affecting hemodialysis patients. It necessitates an urgent and occasionally complicated thrombectomy procedure and increases the risk of AV access loss. AV access stenosis is found in t...

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Autores principales: Salman, Loay, Rizvi, Abid, Contreras, Gabriel, Manning, Christina, Feustel, Paul J., Machado, Ivy, Briones, Patricia L., Jamal, Aamir, Bateman, Nicolle, Martinez, Laisel, Tabbara, Marwan, Vazquez-Padron, Roberto I., Asif, Arif
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609971/
https://www.ncbi.nlm.nih.gov/pubmed/33163714
http://dx.doi.org/10.1016/j.ekir.2020.07.034
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author Salman, Loay
Rizvi, Abid
Contreras, Gabriel
Manning, Christina
Feustel, Paul J.
Machado, Ivy
Briones, Patricia L.
Jamal, Aamir
Bateman, Nicolle
Martinez, Laisel
Tabbara, Marwan
Vazquez-Padron, Roberto I.
Asif, Arif
author_facet Salman, Loay
Rizvi, Abid
Contreras, Gabriel
Manning, Christina
Feustel, Paul J.
Machado, Ivy
Briones, Patricia L.
Jamal, Aamir
Bateman, Nicolle
Martinez, Laisel
Tabbara, Marwan
Vazquez-Padron, Roberto I.
Asif, Arif
author_sort Salman, Loay
collection PubMed
description INTRODUCTION: Arteriovenous (AV) access thrombosis remains 1 of the most troubling AV access–related complications affecting hemodialysis patients. It necessitates an urgent and occasionally complicated thrombectomy procedure and increases the risk of AV access loss. AV access stenosis is found in the majority of thrombosed AV accesses. The routine use of AV access surveillance for the early detection and management of stenosis to reduce the thrombosis rate remains controversial. METHODS: We have conducted a multicenter, prospective, randomized clinical trial comparing the standard of care coupled with ultrasound dilution technique (UDT) flow measurement monthly surveillance with the standard of care alone. RESULTS: We prospectively randomized 436 patients with end-stage renal disease on hemodialysis with arteriovenous fistula (AVF) or arteriovenous graft (AVG) using cluster (shift) randomization to surveillance and control groups. There were no significant differences in the baseline demographic data between the 2 groups, except for ethnicity (P = 0.017). Patients were followed on average for 15.2 months. There were significantly less per-patient thrombotic events (Poisson rate) in the surveillance group (0.12/patient) compared with the control group (0.23/patient) (P = 0.012). There was no statistically significant difference in the total number of procedures between the 2 groups, irrespective of whether thrombectomy procedures were included or excluded, and no statistically significant differences in the rate of or time to the first thrombotic event or the number of catheters placed due to thrombosis. CONCLUSION: The use of UDT flow measurement monthly AV access surveillance in this multicenter randomized controlled trial reduced the per-patient thrombotic events without significantly increasing the total number of angiographic procedures. Even though there is a trend, surveillance did not reduce the first thrombotic event rate.
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spelling pubmed-76099712020-11-06 A Multicenter Randomized Clinical Trial of Hemodialysis Access Blood Flow Surveillance Compared to Standard of Care: The Hemodialysis Access Surveillance Evaluation (HASE) Study Salman, Loay Rizvi, Abid Contreras, Gabriel Manning, Christina Feustel, Paul J. Machado, Ivy Briones, Patricia L. Jamal, Aamir Bateman, Nicolle Martinez, Laisel Tabbara, Marwan Vazquez-Padron, Roberto I. Asif, Arif Kidney Int Rep Clinical Research INTRODUCTION: Arteriovenous (AV) access thrombosis remains 1 of the most troubling AV access–related complications affecting hemodialysis patients. It necessitates an urgent and occasionally complicated thrombectomy procedure and increases the risk of AV access loss. AV access stenosis is found in the majority of thrombosed AV accesses. The routine use of AV access surveillance for the early detection and management of stenosis to reduce the thrombosis rate remains controversial. METHODS: We have conducted a multicenter, prospective, randomized clinical trial comparing the standard of care coupled with ultrasound dilution technique (UDT) flow measurement monthly surveillance with the standard of care alone. RESULTS: We prospectively randomized 436 patients with end-stage renal disease on hemodialysis with arteriovenous fistula (AVF) or arteriovenous graft (AVG) using cluster (shift) randomization to surveillance and control groups. There were no significant differences in the baseline demographic data between the 2 groups, except for ethnicity (P = 0.017). Patients were followed on average for 15.2 months. There were significantly less per-patient thrombotic events (Poisson rate) in the surveillance group (0.12/patient) compared with the control group (0.23/patient) (P = 0.012). There was no statistically significant difference in the total number of procedures between the 2 groups, irrespective of whether thrombectomy procedures were included or excluded, and no statistically significant differences in the rate of or time to the first thrombotic event or the number of catheters placed due to thrombosis. CONCLUSION: The use of UDT flow measurement monthly AV access surveillance in this multicenter randomized controlled trial reduced the per-patient thrombotic events without significantly increasing the total number of angiographic procedures. Even though there is a trend, surveillance did not reduce the first thrombotic event rate. Elsevier 2020-08-04 /pmc/articles/PMC7609971/ /pubmed/33163714 http://dx.doi.org/10.1016/j.ekir.2020.07.034 Text en © 2020 International Society of Nephrology. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Research
Salman, Loay
Rizvi, Abid
Contreras, Gabriel
Manning, Christina
Feustel, Paul J.
Machado, Ivy
Briones, Patricia L.
Jamal, Aamir
Bateman, Nicolle
Martinez, Laisel
Tabbara, Marwan
Vazquez-Padron, Roberto I.
Asif, Arif
A Multicenter Randomized Clinical Trial of Hemodialysis Access Blood Flow Surveillance Compared to Standard of Care: The Hemodialysis Access Surveillance Evaluation (HASE) Study
title A Multicenter Randomized Clinical Trial of Hemodialysis Access Blood Flow Surveillance Compared to Standard of Care: The Hemodialysis Access Surveillance Evaluation (HASE) Study
title_full A Multicenter Randomized Clinical Trial of Hemodialysis Access Blood Flow Surveillance Compared to Standard of Care: The Hemodialysis Access Surveillance Evaluation (HASE) Study
title_fullStr A Multicenter Randomized Clinical Trial of Hemodialysis Access Blood Flow Surveillance Compared to Standard of Care: The Hemodialysis Access Surveillance Evaluation (HASE) Study
title_full_unstemmed A Multicenter Randomized Clinical Trial of Hemodialysis Access Blood Flow Surveillance Compared to Standard of Care: The Hemodialysis Access Surveillance Evaluation (HASE) Study
title_short A Multicenter Randomized Clinical Trial of Hemodialysis Access Blood Flow Surveillance Compared to Standard of Care: The Hemodialysis Access Surveillance Evaluation (HASE) Study
title_sort multicenter randomized clinical trial of hemodialysis access blood flow surveillance compared to standard of care: the hemodialysis access surveillance evaluation (hase) study
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609971/
https://www.ncbi.nlm.nih.gov/pubmed/33163714
http://dx.doi.org/10.1016/j.ekir.2020.07.034
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